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Smaller is Better

New state hospital misdirects precious resources

At a recent panel discussion, local politicians and service provider representatives addressed the pressing need for community services for the mentally ill. Unfortunately, the Legislature chose to direct human service funding to institutional care rather than community-based programs. The soon to be completed State Mental Hospital between Eugene and Junction City is the result of that funding priority decision. 

I was among a very large contingent of individuals opposing the hospital’s construction. Every patient advocacy group opposed it, every professional organization opposed it, and the governor-appointed State Mental Health Commission opposed it. We all supported directing the funding toward community based programs and facilities. 

The emphasis on treatment today, supported by professionals and endorsed by the federal government, is based on the concept of “least restrictive appropriate treatment setting.” We need to realize that locked-ward institutional placement is the most restrictive placement possible and patients should be incarcerated only if no other less restrictive placement is available for their appropriate care. There are now 655 beds available statewide in locked ward institutions. 

Most of the patients in institutional placement are forensic patients, adjudicated to incarceration by court action. They have been hospitalized based on criminal charges and a court decision that they were mentally ill and, therefore, should not be criminally prosecuted, but incarcerated instead. Some of these patients need locked-ward incarceration and the current placement is appropriate; however, according to a summer of 2010 patient statistical survey, 40 percent of the patients were committed based on alleged criminal actions which were not Measure 11 offenses — meaning, those offenses were nonviolent and, if addressed through the criminal justice system, would not have required mandatory prison sentencing. I would suggest that at least a third of them could be served as well, or better in far less restrictive and far more cost-effective community-based residential facilities. 

 The new hospital, according to Jodie Jones, the construction administrator, will cost between $150 million and $200 million to build. The operating budget will be between $48 million and $50 million per year for 174 beds. The cost per bed will be $280,000 per year. 

Community-based services provide drop-in clinics, crisis first responder teams, regular counseling/therapy support programs, crisis care placement and small (usually 16-bed) residential placement facilities. Those residential facilities usually run on a budget of about $70,000 per patient per year. Additionally, they are subsidized by the federal Department of Human Services (DHS) at between 50 and 60 percent. The effective cost is about $35,000 per patient per year; we could treat eight patients in a community-based facility for the cost of one patient in a locked-ward institution. A community-based approach would provide proactive, effective, early intervention to help address mental health issues before an individual commits a crime or harms himself or herself. 

With the nearly $200 million in hospital construction costs and $50 million in annual hospital cost, the state could have built more small community sited facilities across the state. We could have sited care facilities in or near patients’ homes, providing easy access to family support systems and facilitating re-integration. Instead, we’re providing institutional care far from home and families and far from the support system they will need to help re-integrate. We’ve committed millions to an approach which is inappropriate and so expensive that it precludes funding for the development of those more appropriate programs and systems.

We lack the funding for badly needed community-based programs and facilities, we are incarcerating forensic patients in expensive locked wards who could be receiving more appropriate and cheaper care in community-based residential placement, and we are incarcerating mentally ill individuals in our prisons who need psychiatric care the prison system is not designed to provide.

The new hospital was designed so it could be re-purposed to house inmates who need secure psychiatric care rather than prison incarceration. Let’s re-purpose it right now. Let’s transfer it to the Department of Corrections and use it to house those individuals. Let’s transfer the construction cost to the DOC budget and restore that nearly $200 million to the Health and Human Services budget and use it to build community-based residential facilities, crisis care facilities, staffed with crisis first responders, and walk-in mental health clinics. Let’s assess the current population of our mental health institutions and follow those “least restrictive treatment setting” guidelines to, if possible, transfer a significant portion of our institutionalized patients to safe and more treatment effective and cost effective community-based facilities.

We have an opportunity to correct the mistake and redirect mental health funding to community-based services and, at the same time, address the very serious issue of prison inmates who need, instead, to be placed in a secure psychiatric facility. It makes sense to take advantage of that opportunity.